Abstract: Publication date: Available online 5 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Ruchi Garg, Neeraj Garg, D.K. Sharma, Shakti Gupta BackgroundViolence against health-care workers has become a great issue in health-care organizations. This study was conceptualized with the aim to know the prevalence of violence and to identify gap between rate of reporting of an incident of violence at a tertiary care hospital in India.MethodsThe study was descriptive and cross-sectional; a validated questionnaire was used as a tool. Reported incidents of violence against workers were collected. P value
Abstract: Publication date: Available online 5 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Arijit Sen, Divya Gupta, Rajat Jagani BackgroundLight chain restriction needs to be established on the paraffin embedded tissue in certain types of plasma cell dyscrasias when serum levels of monoclonal immunoglobulins and light chain assays in the urine and serum may be normal. Rapid-in-situ-hybridisation (RISH) is thought to be a superior to immunohistochemistry (IHC) for kappa and lambda staining due to brighter and crisp staining without any background.MethodsFifty cases were included in this pilot study. Serum light chain restriction status of the case was taken as gold standard. The results of standard IHC for kappa and lambda immunoglobulins on the bone marrow biopsy of these cases was compared with RISH performed by the two commercially available kits. The results of the two methods were compared for sensitivity, need to repeat the test and background staining.ResultsThe study found that in IHC first run sensitivity was 58% which improved to 88% after the second run. For RISH the sensitivity was 100%.ConclusionRapid-in-situ-hybridisation (RISH) is a superior technique to IHC for detecting kappa and lambda light chain in plasma cells. The test is as labour intensive and time consuming as the routine IHC but has no background staining with more bright and crisp staining quality.
Abstract: Publication date: Available online 5 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): D. Bhattacharyya, A. Timothy, P. Yadav, M. Namdev BackgroundDeliberate self-harm (DSH) is common in modern society. A million people worldwide die from suicide each year, leading to a large toll on human resources and economy. Research has revealed DSH as an important indicator of eventual suicide worldwide. The present study focused on DSH attempters among Armed Forces personnel and family members with the aim of identifying modifiable factors to provide recommendations for primary prevention in the military milieu.MethodsHundred cases of survivors of DSH were evaluated in a case–control study using psychiatry assessment instruments (the Mini-International Neuropsychiatric Interview, Pierce Suicide Intent Scale, Hamilton's Depression and Anxiety Scales and presumptive life event scale) to assess psychiatric morbidity and psychosocial correlates. The findings were compared with those of 100 healthy matched controls. The data were analysed using SPSS software.ResultThe majority of DSH survivors (98%) had concurrent psychiatric morbidity, major depressive disorder (23%) being the commonest diagnosis followed by psychotic disorder and alcohol use disorder. Presence of relationship problems (69%) and financial difficulties (19%) were significant triggering factors in our study. Many DSH attempters had voiced suicidal ideation (66%) before their act and had history of aggression or violence (76%) in the past.ConclusionOur findings are discussed in relation with findings in the literature. Recommendations regarding awareness campaign, specific skill development programs and the need for early intervention in individuals with psychiatric morbidity have been proposed to prevent such behaviours.
Abstract: Publication date: Available online 5 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Swati Bajaj, Puja Dudeja BackgroundFood poisoning outbreaks are commonly seen in mass social events where food is prepared under temporary arrangements. This study reports a food poisoning outbreak in a city of western Maharashtra, India, where around 4000 people had consumed food during a religious community lunch and reported sick to the nearby hospital with complaints of diarrhea, abdominal cramps, fever with chills, and vomiting.MethodsThis was a retrospective–prospective study. Investigation of the food poisoning outbreak was conducted to identify the causes and recommend preventive measures. Interview method was used to elicit food history from the affected and non-affected persons. Inspection of the cooking area was conducted to find the likely source of contamination.ResultsA total of 291 patients reported sick after consumption of meal at a religious mass gathering. The range of incubation period was from 10 hours to 40 hours. Predominant features were diarrhea (100%), abdominal cramps (89%), fever with chills (81%), and vomiting (28.5%). Maximum relative risk of 14.89 was seen for green gram (moong dal) with 95% confidence interval of 2.16–102.6. Keeping the incubation period and clinical profile in view, the likely organisms are enteropathogenic Escherichia coli or Salmonella spp.ConclusionMaintaining food safety during mass gatherings is a major challenge for public health authorities. The Food Safety and Standards Act (2006) in India brings the food consumed during religious gatherings such as 'prasad' and 'langar' under its purview and comprehensively addresses this issue.
Abstract: Publication date: Available online 2 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): J. Sankar, S.S. Majumdar, Manish Unniyal, Harmanpreet Singh, Atul Khullar, Kishore Kumar Central nervous system tuberculoma can have different clinical manifestations like headache, seizures, papilledema or other signs of raised intracranial pressure depending up on the site and number of tuberculoma. We report a case of 56 year old female reported with history of bilateral asymmetric ptosis of one month duration,with no other neurological defecit. Magnetic resonance imaging (MRI) brain revealed well defined ring enhancing lesion in the medial aspect of left hemi midbrain with diffuse disproportionate perilessional edema. Contrast Enhanced Computed Tomogram (CECT) of chest and abdomen revealed features of disseminated tuberculosis. She was diagnosed as a case of disseminated tuberculosis and started on antitubercular therapy with steroids and the ptosis almost resolved after 01 month of antitubercular therapy. Our case report is unique in the sense that only few cases of midbrain tuberculoma causing occulomotor abnormalities are reported in literature.
Abstract: Publication date: Available online 2 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): G.S. Chowdhary, Ritu Mehta, Rahul Tyagi Primary pulmonary Hodgkins lymphoma is a rare and enigmatic neoplasm commonly seen in females. The aim of this case report is to emphasize that pulmonary lymphoma should be considered as a differential diagnosis in a young patient presenting with a lung mass and B symptoms. Extensive clinical details, imaging should be done to rule out the secondary involvement of lung by other lymphomas.
Abstract: Publication date: Available online 2 April 2019Source: Medical Journal Armed Forces IndiaAuthor(s): P.S. Bhat, Jyoti Prakash, Kalpana Srivastava With the advent of internet and mobile communication the virtual space of world wide web has become a playground; people plugged in to it at distant horizon completely unfamiliar to each other are players; keyboard, touchpad and joysticks have become the tools of play; webmaster, app developer are self designated referees of the game; while the virtual media is the largest ever spectators in this amphitheatre of the web. More and more youth are getting hooked onto this and are gradually becoming dependent on these games. World Health Organization has recognized this as a diagnosable medical illness and included as Internet Gaming Disorder (IGD) in its International Classification of Diseases (ICD) -11 released in 2018. Various aspects of this problem are discussed in this article.
Abstract: Publication date: Available online 29 March 2019Source: Medical Journal Armed Forces IndiaAuthor(s): J.S. Gill, Sourav Sen BackgroundAssessment drives learning. Written assessment of many universities lacks uniformity and validation. Subjectivity influences assessment. Blueprinting has been used as content validity tools.MethodsIn this study, last 5-year's Maharashtra University of Health Sciences (MUHS) second year MBBS papers in Microbiology were evaluated for its content validity. Desired weightage to all the topics in microbiology was given by the faculty of Department of the Microbiology. University papers were also evaluated for level of cognitive domain tested. Closed ended feedback from faculty was taken and was statistically evaluated.ResultStudy revealed both overrepresentation and underrepresentation of many topics across all the last 5-year university papers in subject of microbiology. The cognitive dimension tested in question papers as per revised Bloom's taxonomy was merely 8% from Bloom's level 1, 20% from level 2, and 8% from level 3, whereas 64% of the questions were ambiguous. Faculty feedback revealed significant impact (P
Abstract: Publication date: Available online 25 March 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Gurpreet Singh, Seema Patrikar, D.R. Basannar, V.K. Bhatti BackgroundEvidence-based policy decision-making is introduction of newer technology that it is ‘not inferior’ to existing technology. Multiple randomised clinical trials (RCTs) on tuberculosis (TB) treatment have shown mixture of favourable, unfavourable and non-significant changes in outcomes with the use of fixed-dose combination (FDC) regimens. The aim of this study was to assess clinical effectiveness of FDC regimen as compared to the use of separate drugs in anti-TB treatment.MethodsSystematic literature search was carried out. RCTs with newly diagnosed smear-positive pulmonary TB cases were included. Defined outcomes were smear conversion, relapse, adverse reactions and patient compliance.ResultsInitial search revealed 457 articles, out of which 7 were included for meta-analysis. Pooled risk ratio for smear conversion rate at the end of intensive phase was 1.01 (95% confidence interval [CI], 0.99–1.03; p = 0.40). Similarly, smear conversion rate at the end of treatment showed no significant difference (relative risk (RR) = 1.01; 95% CI, 0.99–1.02; p = 0.45). Pooled risk ratio for combined smear conversion rates was 1.01 (95% CI, 0.99–1.02). However, relapse rates showed marginally higher trend with FDC regimens (RR, 1.56; 95% CI, 0.95–2.56; p = 0.49). Pooled analysis for adverse events showed no significant difference (RR = 0.98; 95% CI, 0.86–1.11; p = 0.70). Analysis of patient compliance showed marginal increase among FDC group (RR = 1.02; 95% CI, 0.96–1.09; p = 0.47)).ConclusionFixed-dose combination (FDC) formulations are not inferior in treatment outcomes. It may also ease programme managers and patients by improving compliance. However, increase in relapse rates needs further evaluation through large multicentric studies before implementing policy change in the national programme.
Abstract: Publication date: Available online 26 February 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Anusree Majumder, Rajat Jagani, Atoshi Basu BackgroundBasal-like breast cancer has an unfavorable prognosis. Immunohistochemically, they are predominantly estrogen receptor (ER), progesterone receptor (PR) and CerbB2 receptor (HER2)-negative, show expression of Cytokeratins (CKs) 5/6, CK14, CK 17 and P-cadherin and are associated with germline BRCA1 mutations. Immunohistochemistry (IHC) is an easily available and relatively inexpensive technique that can detect this cancer subtype, and patients can benefit from aggressive management protocols. The aim of this study was to evaluate the expression of CK 5/6 and CK14 in breast cancer and its correlation with age, tumor grade, tumor size, histomorphological pattern, nodal status, ER, PR, HER2/neu, and Ki-67 index.MethodsFifty treatment-naїve patients of breast carcinoma who underwent surgery constituted the study group. No core cut biopsy specimens were considered. Histopathological examination along with IHC was performed for CK5/6, CK14, ER, PR, HER2/neu, and Ki-67. Comparison between the expression of CK5/6 and CK14 with age, tumor size, tumor grade, histological subtype, nodal status, ER, PR, HER2/neu, and Ki-67 expression was performed using SPSS 20 version software.ResultsTwenty-six percent of cases showed expression of CK5/6 and CK14. CK5/6 and CK14 expression correlated strongly with ER/PR negativity, young age, and Ki-67 proliferative index greater than 15%. No significant association with HER2/neu negativity was demonstrated. Contrasting results were obtained between CK5/6 and CK14 expression with respect to tumor grade and lymph node status.ConclusionIHC can be used to identify patients with basal phenotype breast cancer with good sensitivity and specificity, and such patients can benefit from aggressive management.
Abstract: Publication date: Available online 26 February 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Narendra Kumar, R.K. Dhiman, Vimal Arora, V.K. Baranwal, K.R. Krishnaprasad, Bahri Pearl BackgroundThis study was aimed to evaluate the changes in salivary output and its effect on dental caries among Indian troops after 6 months of stay at high-altitude area (HAA).MethodsAll troops undergo mandatory dental checkup during acclimatization phase before deployment at HAA. Two thousand troops who fulfilled inclusion and exclusion criteria were selected, and consent for the study was obtained. Stimulated and unstimulated salivary samples were collected, the decayed, missing, and filled teeth (DMFT) index was evaluated, and required dental treatment was completed. The same salivary samples were collected after 6 months (on deinduction) to evaluate the salivary output. The DMFT index was re-evaluated to check the initiation of caries.ResultsThe mean values of unstimulated and stimulated saliva at the initial visit were 4.105 and 17.03 gm, respectively, whereas the mean values of unstimulated and stimulated saliva after 180 days were 3.034 and 15.831 gm, respectively. Salivary flow was found to be significantly decreased after 6 months both in unstimulated and stimulated saliva. The mean DMFT at the time of induction of the study was 6.18 ± 3.03, and on deinduction, it was 7.22 ± 3.45 with p
Abstract: Publication date: Available online 23 February 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Puneet Takkar, Rajat Prabhakar BackgroundStress fractures (SFs) occur because of repetitive submaximal stresses to the bone over a period of time. SFs cause an economic loss to the organization and to the individuals who get invalided out of army because of SFs. This study was conducted to determine the incidence, distribution, onset of SFs, and invalidment patterns due to SFs.MethodsThis prospective study was carried out among recruits undergoing training at training centres in a cantonment of Central India. The recruits enrolled were followed up through their training period for occurrence of SF. On occurrence of SF, the clinical features, site of bone involved, and the weeks of completed military training were noted. The SFs were graded into four grades based on clinicoradiological features and managed accordingly.ResultsA total of 8974 recruits were enrolled into the study, of which 208 recruits suffered SFs. The commonest bone involved was the tibia (86.5%), commonest site being the proximal one-third of the tibia shaft (46.2%). Average week of developing SF was the 15th week of training. Seven recruits were invalided out of army because of SFs, the commonest cause being femoral neck SFs.ConclusionPrevention is the best approach for SFs. It is suggested to increase the intensity of training gradually over the first 16 weeks and recruits are to be given a training pause at around the 12th week for healing of stressed bones just before the peak time of occurrence of SFs. Femoral neck SFs are the commonest SFs responsible for invalidment of recruits.
Abstract: Publication date: Available online 12 January 2019Source: Medical Journal Armed Forces IndiaAuthor(s): Avadhesh Oli, D. Joshi BackgroundThe aim of this study was to evaluate the efficacy of red contact lens in improving color vision test performance based on Ishihara, Farnsworth D15, and Martin Lantern Test (MLT).MethodsThirty subjects with a known color vision defect were enrolled after consent. The color vision was assessed using Ishihara test, D15 test, and MLT. The error scores were recorded. The test was repeated after using a red contact lens.ResultsThe mean error scores were 7.87 (±1.00), 3.33 (±3.15), and 5.67 (±2.52) on Ishihara, MLT, and D15 test, respectively. The error scores reduced to 3.93 (±3.78), 1.33 (±1.34), and 2.77 (±2.12) Ishihara, MLT, and D15 test, respectively (P value
Abstract: Publication date: Available online 11 January 2019Source: Medical Journal Armed Forces IndiaAuthor(s): J.S. Sandhu, Ajit K. Singh, Abhijit Bhatulkar, Uday Pratap, Milind Chauhan BackgroundUreteroscopic management of ureteral calculi using topical anaesthesia has been described. Most studies topically anaesthetized the urethra or urinary bladder by instilling 2% of plain lignocaine. In addition to the success rate, the pain perception in these studies was reported subjectively using non-standard criteria. Topical anaesthesia of the ipsilateral ureter and the pelvicalyceal system (PCS), in addition to urethra and urinary bladder, and use of alkalinised lignocaine, for enhanced effect, has not been reported for ureteroscopy. Using these conceptual alterations, we tested the safety and efficacy of performing ureteroscopy and laser lithotripsy under our technique of total intraluminal topical anaesthesia (TILTA).MethodsOne hundred sixty-eight patients underwent ureteroscopic laser lithotripsy by topical instillation of alkalinised lignocaine into the urinary bladder and ipsilateral ureter and PCS. Self-assessed pain perception and changes in vital parameters were objectively scored at various times. The success rate, reasons for failure, maximum pain scores, complications, and willingness to undergo repeat procedure were recorded.ResultsThe success rate was 91.3% with a mean duration of 14.7 minutes Double J Stent (DJS) was placed in 38.1%. 61.3% patients did not need any postoperative injectable analgesic, with 11.3% requiring more than a single dose. The intraoperative changes in vitals initially and at the height of pain were not statistically significant (p>0.05). Self-assessed median pain scores between intravenous access placement and ureteroscopy were significantly different (p
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Amit Rai, Anurag Khera, Mehul Jain, Mathangi Krishnakumar, D.K. Sreevastava BackgroundThe use of intravenous (IV) cannulas is an integral part of patient care in hospitals. These intravenous cannulas are a potential route for microorganisms to enter the blood stream resulting in a variety of local or systemic infections. Studies showing the actual prevalence of colonization of peripheral IV cannulas and its role in BSI are lacking. Hence, this study was aimed to estimate the prevalence of colonization of the injection ports of peripheral IV cannulas.MethodsThis cross sectional study was conducted on patients admitted in ICU and wards in an 800 bedded tertiary care hospital. Swabs were taken from lumens of peripheral IV cannulas and cultured. Patient demographic data and practices followed for maintenance of IV line were noted.ResultsA total of 196 injection port samples were taken, out of which 11 tested positive for microbial growth (5.61%). Staphylococcus aureus was the predominant organism contributing 64% of the microbial growth. A significant association was seen between presence of local signs, old age and positive cultures. Flushing IV cannula every 6 h was associated with negative cultures.ConclusionPeripheral IV cannulation has significant potential for microbial contamination and is largely ignored. Most of the risk factors associated with growth of microorganisms in the injection ports of peripheral intravenous cannulas (which has a potential to cause catheter-related blood stream infections) can be prevented by improving protocols for management. To prevent infection from occurring, practitioners should be educated and trained about the care and management of IV.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): A. Agarwal, C.D.S. Katoch, M. Kumar, T.N. Dhole, Y.K. Sharma BackgroundMicroscopic observation drug susceptibility (MODS) assay has been suggested as a low cost method for rapid, accurate detection of tuberculosis (TB) and multidrug resistant tuberculosis (MDR-TB).MethodsA total of 2424 samples collected from 1063 eligible patients of suspected pulmonary or extrapulmonary TB were subjected to MODS assay. Performance of MODS was compared with culture and drug susceptibility testing (DST) by conventional solid Lowenstein–Jensen (LJ) media or liquid Mycobacteria Growth Indicator Tube (MGIT) culture.ResultsWhen compared to reference gold standard of positivity in either solid or liquid reference culture, the MODS assay had sensitivity, specificity, positive predictive value and negative predictive value of 91.3%, 98.2%, 96.0% and 95.9% respectively. MODS took a median time of 10.3 days to culture positivity as compared to 13.8 days using MGIT and 30.5 days using LJ culture. Culture and DST being concurrent in MODS, the median turnaround time for DST was the same as that for culture i.e. 10.3 days. The overall median turn around time for culture positivity and DST using manual MGIT and LJ medium was 23.6 days and 61.2 days respectively. The concordance between MODS culture and the reference susceptibility method was 97.7% for rifampicin, 95.6% for isoniazid, 98.5% for rifampicin and isoniazid. The cost of performing a single MODS assay was INR 200.ConclusionMODS is a rapid and sensitive, yet simple and inexpensive test that may be helpful to enhance diagnostic accuracy, and case detection of TB and MDR-TB in resource constrained settings.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): P. Vijendran, R. Verma, N. Hazra, B. Vasudevan, M. Debdeep, V. Ruby, N. Shekar BackgroundDermatological diseases are the first recognized clinical manifestation Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS).1, 2 The present study was undertaken to find out the clinical spectrum of the superficial mycoses, the etiological organisms and their drug sensitivity patterns among HIV positive patients and non HIV individuals attending the tertiary care hospital.MethodsThe study population was 100 HIV patients and control patients were consecutive 100 HIV negative patients. Skin scrapings and swabs were obtained from the upper back, web spaces of toes, inguinal region, dorsum of tongue. All the samples were subjected to potassium hydroxide mount and stained with Calcoflour White and were cultured. The fungi were identified on the basis of colony and microscopic features in conjunction with results of physiologic evaluation by standard phenotypic identification criteria.ResultsThe total number of seropositive patients who had atleast one fungal infection was 57 and the total number of seronegative patients who had atleast one fungal infection was 21. In our study, fungal colonization was seen in 3.6% in clinically normal sites in retropositive patients and 1.6% in retronegatives. 76.59% in retropositive and 85.71% in retronegative patients the fungi cultured were sensitive to fluconazole.ConclusionThe findings of this study suggest that the skin of HIV patients may more frequently harbour common fungi even in the absence of visible clinical signs. Antifungal-resistant fungi should be kept in mind while treating fungal infections.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Mahadevan Kumar, M. Mugunthan, Rajan Kapoor, Suresh Pandalanghat BackgroundInvasive fungal diseases (IFDs) are difficult to diagnose and associated with high mortality rates, especially in the immunosuppressed. Species of Aspergillus and Candida are the cause of majority of invasive fungal disease however IFDs are also caused by Fusarium, Zygomycetes, Trichosporon, etc. Early detection is crucial for appropriate antifungal therapy. Blood cultures usually fail to isolate filamentous fungi, while detection of circulating beta-d-glucan or galactomannan antigens show variable sensitivity and specificity. There is a need of reliable, sensitive and specific diagnostic tests for IFDs.MethodsA real-time Polymerase Chain Reaction (PCR) assay with a universal primer/molecular beacon system was developed for detecting and speciating most of the pathogenic fungi implicated in IFD. A single-reaction assay was designed targeting a carefully selected region of the ITS2 and ITS5 subunits of the fungal rDNA gene along with four molecular beacons capable of differential hybridization to the amplicons of different species. This generated a signature set of melting temperatures using the standard strains. The assay was tested on clinical specimens from patients with suspected invasive fungal disease.ResultsThe assay was tested on 72 clinical samples and 72 healthy controls. Of these, 22 clinical samples (6/8 proven; 13/29 probable; 3/35 possible IFD, classified by the EORTC/MSG criteria) were positive by PCR and generated a set of melting temperatures enabling identification of the causative fungus. The assay was negative in all healthy controls.ConclusionThe molecular beacon assay is a promising tool providing a rapid method for detection and monitoring of invasive fungal disease in immunosuppressed patients.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Indranil Saha, Bobby Paul Tuberculosis (TB), one of the oldest diseases known to mankind has become a notifiable disease. Public private mixes guidelines for TB programme managers had already been published by Central TB Division in the Ministry of Health and Family Welfare. One of the tremendous challenges that impede private sector involvement in TB care is delayed diagnosis, treatment of variable quality, surveillance, adherence monitoring, contact investigation, and outcome recording. The present article has addressed the involvement of the private sector with special emphasis on Tuberculosis Health Action Learning Initiative (THALI) model. The key elements of THALI being: (1) Identifying and scaling up of innovative approaches to improve the quality of private sector diagnosis, referral, and treatment of TB, (2) Strengthening the utilization of TB resources of the respective municipalities, (3) Testing of upcoming technological innovations, and (4) Improving data for evidence-based decision making. Nevertheless, sustainable parallel implementation framework adopting the strategies of THALI Model, along with prior Geographic Information System mapping of private health facilities e.g. hospitals/nursing homes, private providers, diagnostic centres, pharmacies etc. should be in place so as to correctly implement the slogan – “Unite to end TB: Leave no one behind”.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): J.S.V. Soundarya, Uma Devi Ranganathan, Srikanth P. Tripathy Despite the global efforts made to control tuberculosis (TB) and the large number of available new anti-TB drugs, TB still affects one-third of the world population. The conventional vaccine bacille Calmette–Guérin (BCG) shows varying efficacy in different populations, and there are safety issues in immunocompromised patients. Hence, there is an urgent requirement for a new and better TB vaccine candidate than BCG. There are several alternate vaccines available for TB such as DNA, subunit, adjuvant, and live-attenuated vaccines. Use of auxotrophic vaccine is an emerging technology. Newer vaccine technologies include vaccine delivery methods such as adenovirus- and cytomegalovirus (CMV)-based vector delivery, chimeric monoclonal antibody, single-chain fragment variable, RNA-lipoplexes, and nanoparticle-based technology. Based on its application, TB vaccines are classified as conventional, prophylactic, booster, therapeutic, and reinfection preventive vaccines. Currently, there are 12 vaccine candidates in clinical trials. In this review, we have briefly discussed about each of these vaccines in different phases of clinical trials. These vaccines should be analyzed further for developing a safe and more efficacious vaccine for TB.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Rina Tilak, Renuka Kunte Scrub typhus has struck back, albeit with renewed vigour, impacting areas with previously known endemicity as also impressing newer expanses. It is not surprising, therefore, that Scrub typhus has emerged as a leading cause of public health concern globally as well as in India, but are we ready to take on the challenge'Over the last decade, there has been a global increase in the number of outbreaks of Scrub typhus, be it the military occupied areas or the civil population at large. The innumerable outbreaks of Scrub typhus, although disconcerting, have nonetheless contributed phenomenally towards better understanding of the dynamics of scrub typhus. There have been significant contributions to awareness of the disease amongst medical professionals, scrub typhus as a cause of Acute Undifferentiated Febrile Illness (AUFI) and newer clinical manifestation – Acute Encephalitis Syndrome (AES), availability and advances in diagnostics and management, man-vector-pathogen interactions, new records of Leptotrombidium species, newer vectors and Orientia species.Antigenic diversity and the varied clinical presentation of scrub typhus, absence of scrub typhus surveillance system and a lack of political will to recognize the disease as one of the important reemerging public health problem are areas seeking concerted deliberations and actions so that the challenges posed by scrub typhus can be addressed.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Zinia T. Nujum, N. Saritha, M.R. Prathibha Raj, A.V. Gayathri, C. Nirmala, K. Vijayakumar, Sara Varghese BackgroundPregnant women and infants are vulnerable for developing severe dengue. This study was conducted to determine the seroprevalence of dengue infections among pregnant women, their offsprings and its association with outcomes.MethodsA cross-sectional study was conducted among pregnant women, admitted for delivery in a tertiary mother and child hospital in Thiruvananthapuram. Blood specimens (2 ml) were collected from the women during hospitalization in the first stage along with blood samples being drawn for other investigations. Umbilical cord blood was collected from the neonates. The samples were tested using IgG enzyme-linked immunosorbent assay (ELISA). Quantitative titres were also obtained, and index ratios were calculated using optical density values.ResultsSeroprevalence of dengue in antenatal women was 6.9% (95% confidence interval [CI]: 3.4–12.48). Among cord blood samples, the seropositivity was 10.8% (95% CI: 6.3–16.6). A significant correlation (Spearman rho: 0.653 and p value
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Deepshikha Bhowmik, Shiela Chetri, Deepjyoti Paul, Debadatta Dhar Chanda, Amitabha Bhattacharjee BackgroundIn Staphylococcus aureus, methicillin resistance is exhibited by modifications in penicillin-binding protein that minimises the binding affinity to beta-lactam antibiotics. The present study investigated the occurrence of methicillin-resistant S. aureus (MRSA) in community-acquired infections, that is, community-acquired MRSA (CA-MRSA) and in-hospital–acquired infections, that is, hospital-acquired MRSA (HA-MRSA) from Northeast India.MethodsA total of 197 consecutive non-duplicate isolates were collected from Silchar Medical College and Hospital and other private diagnostic laboratories. The isolates were confirmed to be S. aureus at our centre. All isolates were subjected to antibiotic susceptibility testing and were screened for methicillin resistance using cefoxitin disc test. All MRSA were subjected to Polymerase Chain Reaction (PCR) assay for detection of mecA and mecC genes. DNA fingerprinting was performed for determining clonal diversity.ResultsSeventy-one isolates of 127 confirmed S. aureus were found to be methicillin resistant by screening test. mecA gene was detected in 43 isolates, and none of the isolates were positive for mecC gene. Linezolid and teicoplanin showed better activity with susceptibility pattern being 83.6% and 72.44%, respectively, whereas 66.14% were sensitive to vancomycin. Other antibiotic showed low level of activity. Pulsed Field Gel Electrophoresis (PFGE) showed 14 different banding patterns that suggest isolates were of different clonal types.ConclusionmecA was responsible for methicillin resistance in majority of strains. Polyclonal spread of MRSA infection in the study area indicates its diverse origin and possible lateral transfer. Thus, this study is of clinical interest in terms of selection of proper antimicrobial chemotherapy and infection control management.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Sangeeta Joshi, Ranjeeta Adhikary, Hosdurg Bhaskar Beena, Malavalli Venkatesh Bhavana, Rajvir Bhalwar BackgroundEnteric fever is endemic in India. Trends in antibiotic resistance in Salmonella enterica subspecies enterica serovars Typhi and Paratyphi A isolates over the past 12 years were studied.MethodsA retrospective analysis of consecutive blood culture isolates of Salmonella Typhi and Salmonella Paratyphi A was performed from 2002 to 2013. Antibiotic susceptibility testing was carried out for ampicillin, chloramphenicol, cotrimoxazole, nalidixic acid (NA), ciprofloxacin and ceftriaxone by disc diffusion. The minimum inhibitory concentration of ciprofloxacin and azithromycin was determined using E-test strips. Mantel-Haenszel extended chi-square test was used for analysis of trends across years.ResultsThree thousand two hundred ninety-six Salmonella spp. were isolated; of which, 1905 were identified as Salmonella Typhi (58%) and 1393 as Salmonella Paratyphi A (42%). Multidrug resistance (chloramphenicol, ampicillin and cotrimoxazole) was relatively stable throughout the study period. NA resistance increased from 18% in 2007 to 100% in 2013 among Salmonella Paratyphi A isolates and from 67% to 82% among Salmonella Typhi isolates. Complete susceptibility to ceftriaxone and azithromycin was observed in this study.ConclusionsKnowledge of the local patterns of resistance would help in appropriate therapy for enteric fever. With increasing rates of fluoroquinolone resistance in our hospital setting, it is probably prudent to revert back to the first-line agents for treatment and save azithromycin and third-generation cephalosporins for difficult and non-responsive cases.
Abstract: Publication date: January 2019Source: Medical Journal Armed Forces India, Volume 75, Issue 1Author(s): Partha Roy, Anubha Patel, Kavita Lole, R.M. Gupta, Arun Kumar, S. Hazra BackgroundWorldwide prevalence of Hepatitis C virus (HCV) infection hemodialysis (HD) ranges from 1 to 84.6% with serious complications. Assessment of prevalence, risk factors, and genotyping of HCV infection in patient on HD was carried out at Pune, India.MethodsA total of 250 patients on HD from five HD centers were recruited and tested for anti-HCV antibody using third-generation enzyme-linked immunosorbent assay (ELISA). Qualitative HCV RNA detection was carried out by nested reverse transcriptase polymerase chain reaction (RT-PCR). Genotyping and sequencing were carried out using the BigDye Terminator cycle sequencing ready reaction kit.ResultsMean age of patients was 47.3 years. Forty-seven cases out of a total of 250 were reactor for HCV antibody. Overall prevalence rate was 18.8% ranging from 6.7% to 35.6% in the five centers. Of total, 44.1% of females and 13.5% of males were HCV infected. The mean duration of HD in HCV-infected patients was 6.03 years. Prevalence was higher in patients aged> 5 years on HD with higher number of blood transfusions. Thirty-six cases were positive for HCV RNA. Only one HCV RNA was detected among the 203 anti-HCV negative samples. Discordance between antibody and HCV RNA positivity was noted. Seventeen infected cases had changed dialysis centers four times. Thirteen cases were HBsAg positive, of which six cases were coinfected with HCV. Thirty-seven samples were genotyped.ConclusionThe predominant genotype was 1a (54.1%) followed by 1b (43.2%) and 3a (2.7%). Highest prevalence of HCV (35.6%) and intracenter PNI of 99.3% of genotype 1b (84.6%) in center 3 indicates a possible nosocomial transmission.
Abstract: Publication date: Available online 20 December 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Shalendra Singh, Navdeep Sethi An incidence of 30–40 deaths per triennium in pregnant patients is reported because of brain pathology. Over the last two decades, the obstetric cause of mortality in the pregnant patient has declined, but the trend is rising for non-obstetric cause of mortality. Pregnancy is associated with a host of anatomical and physiological alterations that complicate the conduct of anesthesia. The brain is one of the vital organs of the body, and physiological changes during pregnancy alter the anesthesia management if associated with brain pathology. Malignant brain tumors and trauma remain a leading cause of indirect maternal mortality. Review of literature revealed paucity of evidence-based neuroanesthesia management for such patients. Navigating these uncharted waters remains a challenging exercise. With the lack of guidelines, the management is based largely on few case reports or case series.
Abstract: Publication date: Available online 20 December 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Narendra Yadav, Anuj Kumar, Uma Mahajan, Karuna Datta BackgroundWeightlifting is a power and dynamic strength game. Performance of weightlifters during competition depends on absolute and relative power output achieved by them. To enhance power and strength in weightlifters, training programmes have frequent high-intensity exercise sessions. On an informal interaction with the sportspersons, they often complain of problems after intense training. There was a felt need to analyse the problems they perceive after intense training.MethodA feedback form was developed after brainstorming with coaches and sports medicine physicians of a sports institute. Thirty-six male weightlifters aged 19.78 ± 4.71 yrs (mean ± standard deviation) of an institute participated after obtaining informed consent. The feedback form was collected and analysed.ResultAfter an intense exercise, participants reported complaints such as increased fatigue (n = 27), sleep problems (n = 26), restlessness (n = 18) and decreased appetite (n = 12). Of the sleep problems, 69.4% (n = 25 out of 36) noticed worsening of sleep, 50% (n = 18) noticed sleep was light after intense training, 58.3% (n = 21) felt difficulty in falling asleep, 47.2% (n = 7) complained of frequent waking up during sleep at night and 77.8% (n = 28) felt sleepy after waking up.ConclusionIntense training encounters certain problems such as fatigue, sleep disturbances, restlessness and decreased appetite.
Abstract: Publication date: Available online 20 December 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Mahadevan Kumar, S.P.S. Shergill, Kundan Tandel, Kavita Sahai, R.M. Gupta BackgroundTimely initiation of appropriate antimicrobial can improve the outcome in terms of reduced morbidity and mortality in addition to reduced health-care costs. Availability of early preliminary Antimicrobial Susceptibility Test (AST) report will be useful in directing antimicrobial therapy. The aim of the study was to correlate AST by disc diffusion method, directly from positively flagged blood culture bottles, with the AST by automated method.MethodsA total of 144 aerobic blood culture bottles flagged positive by the automated blood culture system were processed. The bacteria were pelleted by two-step centrifugation of the broth from the bottle and used to make a smear for Gram stain as well as an inoculum for antimicrobial sensitivity testing by Kirby Bauer disc diffusion method. Automated identification and AST were also carried out.ResultsOn direct staining, 94 samples showed gram-negative bacilli, 39 showed gram-positive cocci, and 11 showed yeasts or polymicrobial growth. In the case of gram-negative bacteria, there was 99% categorical agreement between direct sensitivity testing and automated sensitivity testing with 1% disagreement. Among the gram-positive cocci, there was 96% categorical agreement with 4% disagreement between the two methods.ConclusionHigh degree of agreement between the two methods is promising and applicable to situations where automated sensitivity testing is not available. Even if the systems are available, this method would prove useful as an adjunct to standard AST reporting. This sensitivity report can be generated earlier than the conventional AST, enabling choice of appropriate antimicrobial.
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Bobby Paul, Indranil Saha From time immemorial, the body of scientific knowledge has grown with incremental additions of research. Metrics-based research evaluation provides crucial information regarding research credibility that would be difficult to understand by means of individual expertise. h-index and its modifications give an approximate quantitative measure of research output. Furthermore, g-index, e-index, ħ-index and i10-index address various intricacies involving authorship. Altmetrics and Plum X metrics are newer usage metrics that put an additional weightage on the impact on social media, usage, capture and scholarly networking. Indirect evaluation of research can also be obtained from the Journal Impact Factor in which the research is published but with certain limitations. While the scientific community is still waiting for a unique one-stop solution based on a high-quality robust process to exert judgement on research, the Leiden Manifesto comprising ten principles for research assessment can act as a guiding tool for development of a comprehensive evaluation system.
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Antonio Ventriglio, P.S. Bhat, Julio Torales, Dinesh Bhugra The sexual physical act is related to sexual attraction, sexual fantasy and sexual behaviour. Fetish has been recognised as an attraction to objects with the aim of achieving sexual gratification. There have been historical accounts of fetishism, and the subject has been of significant interest to clinicians especially those who work in the field of managing mental illnesses. There are various types of fetishism. Reported for the first time in the 19th century, the condition is of various subtypes. Of these, fetishistic disorder can be recognised as sexual fantasies, sexual urges and sexual behaviours which cause significant distress or impairment in an individual in social, occupational or other important areas of function. Fetishism may be related to specific body parts, non-living objects or others. In clinical settings, patients with fetishistic disorders are often referred because of having got into trouble with the law. Fetishism needs to be differentiated from paraphilias. Various explanations including psychoanalysis and behavioural theories have been offered to explain the genesis and management of fetishistic disorders. A fetish is attraction to an object. Treatments can include behavioural, cognitive or psychoanalytic strategies. In this review article, a brief overview on the fetish is offered with suggestions for management.
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Manu Krishnan, Anu Sharma, Seema Saraswathy, Brijesh Tiwari, Gurudatta Ganganahalli, Sanjay Londhe, Ajay Kumar Singh, Velu Nair BackgroundConsidering the limitations in isolating Bone Marrow Mesenchymal Stem Cells (BMSCs), alternate sources of Mesenchymal Stem Cells (MSCs) are being intensely investigated. This study evaluated dental pulp MSCs (DP-MSCs) isolated from orthodontically extracted premolar teeth from a bone tissue engineering perspective.MethodsMSCs isolated from premolar teeth pulp were cultured and studied using BMSCs as the control. Flow cytometry analysis was performed for the positive and negative MSC markers. Multilineage differentiation focusing on bone regeneration was evaluated by specific growth induction culturing media and by alkaline phosphatase (ALP) activity. Data were compared by repeated measurement analysis of variance and Student's t-test at a p value
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Debabrata Mukherjee, Ranjith K. Nair, Sourabh Sharma, Bhaskar Datt, Ananth Rao, Sudeep Prakash BackgroundRenal transplantation in developing countries like India is largely live donor transplantation. Cadaveric transplantation comprises
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Mathews Jacob, Maj MN. Kale, Brig Shahabaz Hasnain BackgroundTraumatic brain injury (TBI) is known to be an important reason for the increase in disabilities and deaths worldwide. Studies have demonstrated that brain tissue oxygen (PO2) monitoring reduces mortality significantly but is a invasive method of monitoring. Therefore, there is a need to monitor cerebral ischemia in TBI by noninvasive methods. The study aims to correlate cerebral co-oximetry and possible outcomes in patients with TBI.MethodsThe study included 78 patients with TBI admitted in intensive care unit (ICU) with glascow coma scale (GCS) of 8 or less than 8. Near-infrared spectroscopy monitor is applied to the patients immediately after admission to ICU; readings are noted every 4 hours up to first 48 hours, and outcomes studied as survival or neurological deficit are noted at 28 days.ResultsA total of 12 (15.4%) deaths were seen in this study. Survived patients were further divided into good recovery 33 (42.3%), moderate disability 21(26.9%), major disability 8 (10.3%), and persistent vegetative state 4 (5.1%). The rSO2 values in surviving patients were ranging from mean of 60.74% (standard deviation [SD] 4.38) to a mean of 64.98% (SD 5.01), and the mean rSO2 values in patients who died were ranging from a mean of 52.17% (SD 4.11) to a mean of 37.17% (SD 12.48). Lower rSO2 values were correlating significantly with worse neurological outcome or death by using two independent sample t-test (p < 0.001).ConclusionCerebral co-oximetry is a simple noninvasive method for predicting the outcomes in TBI and can be used to guide the management of these patients.
Abstract: Publication date: Available online 22 November 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Rajkumar Maurya, Cmde B. Jayan, Rajat Mitra, Oonit Nakra, Uday Kamat BackgroundThe objective of the study was to analyze the quality control of the treatment within the orthodontic department by determining the workload, type of treatment, and quality of outcome.MethodTwo hundred eighty patients were selected from departmental archives, who underwent orthodontic treatment since January 2010 and assessed using index of complexity, outcome and treatment need. Descriptive statistics was performed by SPSS, version 21 (IBM, USA). Mann–Whitney U test was applied to assess the difference between complexity and improvement grade.ResultOrthodontic treatment was provided to 56.43% of female and 43.57% male patients with a mean age of 16.91 years. Angle's class I type malocclusion was the highest with 35.71%. Preadjusted edgewise metal appliance with 95% dominated the mechanics. About 12.14% and 3.57% patients got benefited with myofunctional and orthopedic treatment, respectively. Ten percent of patients were treated with orthognathic surgery. The mean duration of treatment was 31.19 months with a range of minimum of 17 months to a maximum of 46 months. Among 87.14% patients treated by faculty, 47.95% had difficult complexity grading and 22.95% had very difficult complexity grading. Residents had provided treatment with 63.88% difficult and 19.44% very difficult grade. Mann–Whitney U test of overall complexity and improvement grade showed Z score of −9.25715 which was highly significant.ConclusionThe present study concludes that fair quality control is being maintained by the department considering the number of patients, its severity, and excellent outcomes. However, being the premier institute of Indian Armed Forces, regular clinical audit should be conducted to fulfill demand and supply ratio in appropriation.
Abstract: Publication date: Available online 25 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Anubhav Shivpuri, Rajat Mitra, Vivek Saxena, Abhay Shivpuri Teeth present at the time of birth are called natal teeth while the teeth which erupt within 30 days of birth are neonatal teeth. The natal and neonatal teeth are an uncommon occurrence causing extreme anxiousness among the parents because of various myths related to their occurrence in our society. We present a retrospective analysis of 12 cases reported to us with natal and neonatal teeth.
Abstract: Publication date: Available online 25 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Uma Patnaik, Ajith Nilakantan, Ram Bajpai, Kalyani Addya BackgroundRhinoplasty has a tremendous psychosocial impact. A good surgical correction may not guarantee an expected response from the patient. This is due to the fact that there may be associated psychological distress, the assessment of which may have to be incorporated while evaluating the surgical result. We aimed to identify if the questionnaire may help in identifying patients who might be less satisfied psychologically to the surgical result. This aspect of psychological assessment is not standardized, although it is reported in Western literature and recently in Asian Koreans. Similar studies in an Indian scenario merit deliberation.MethodsFifty-one patients who underwent cosmetic rhinoplasty from August 2011 to July 2013 were administered the Derriford Questionnaire preoperatively and postoperatively at 3 months at a mid-zonal hospital. The responses were scored on a five-point Likert scale and analyzed.ResultsThe overall postoperative score improved from 1.32 ± 0.24 to 1.27 ± 0.24. There was statistically significant improvement in subscales of general, sociosexual, and bodily self-consciousness of appearance. However, the improvement in facial self-consciousness of appearance and negative self-concept was not statistically significant.ConclusionWe recommend the use of the Derriford Assessment Scale (DAS) for objective assessment of psychological distress associated with living with a problem of appearance, in addition to assessment of anatomical deformity in patients undergoing cosmetic rhinoplasty. Better preoperative counseling may benefit those with a high score for negative self-concept and facial self-consciousness of appearance.
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Saurabh Karmani, Abhishek Pandey, G. Shridhar, A.K. Simalti, J.N. Goswami
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Anmol Sharma, Rina Tilak, Nikhil Sisodia BackgroundIncreasing rate of vector transmission of dengue has led to the exponential rise in the mortality and morbidity scales in the past five years. There are various natural and synthetic chemical agents available commercially as potent larvicides, but they are either highly toxic, difficult to obtain, have a high manufacturing cost, or show cross-resistance, hence do not suffice as ideal larvicides. The objective was to screen aqueous extracts of Bougainvillea spectabilis (B. spectabilis), Saraca asoca (S.asoca), and Chenopodium album (C. album) for larvicidal activity against Aedes aegypti (A. aegypti).MethodsThe larvae were exposed to increasing concentrations of aqueous extracts of B.spectabilis, S.asoca, and C.album under controlled laboratory environment. The mortality was checked after 24 hours, results were statistically analyzed, and LC50 and LC90 were determined.ResultsB.spectabilis and S.asoca were found effective as larvicides against A.aegypti with LC50 values of 0.22% and 0.26%, respectively.ConclusionThe aqueous extracts of B.spectabilis and S.asoca are efficient larvicides against A.aegypti and can be used as effective, accessible, and eco-friendly control options for management of A.aegypti, the vector of dengue/chikungunya.
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Anusree Majumder, S. Srivastava, P. Ranjan
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Hari Mukundan, Deboleena Mukherjee, Kirti Tyagi, Sachin Taneja, Subhash Ranjan, Samaresh Sahu BackgroundInaccuracies in treatment setup during radiation therapy for breast cancers may increase risks to surrounding normal tissue toxicities, i.e. organs at risks (OARs), and compromise disease control. This study was planned to evaluate the dosimetric and isocentric variations and determine setup reproducibility and errors using an online electronic portal imaging (EPI) protocol.MethodsA total of 360 EPIs in 60 patients receiving breast/chest wall irradiation were evaluated. Cumulative dose–volume histograms (DVHs) were analyzed for mean doses to lung (V20) and heart (V30), setup source to surface distance (SSD) and central lung distance (CLD), and shifts in anterior-posterior (AP), superior-inferior (SI), and medial lateral (ML) directions.ResultsRandom errors ranged from 2 to 3 mm for the breast/chest wall (medial and lateral) tangential treatments and 2–2.5 mm for the anterior supraclavicular nodal field. Systematic errors ranged from 3 to 5 mm in the AP direction for the tangential fields and from 2.5 to 5 mm in the SI and ML direction for the anterior supraclavicular nodal field. For right-sided patients, V20 was 0.69–3.96 Gy, maximum lung dose was 40.5 Gy, V30 was 1.4–3 Gy, and maximum heart dose was 50.5 Gy. Similarly, for left-sided patients, the CLD (treatment planning system) was 25 mm–30 mm, CLD (EPIs) was 30–40 mm, V20 was 0.9–5.9 Gy, maximum lung dose was 45 Gy, V30 was 2.4–4.1 Gy, and maximum heart dose was 55 Gy.ConclusionOnline assessment of patient position with matching of EPIs with digitally reconstructed radiographs (DRRs) is a useful method in evaluation of interfraction reproducibility in breast irradiation.
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Radhika H. Umale, M.A. Khan, P.S. Moulick, Sandeep Gupta, Sandeep Shankar, Alok Sati BackgroundAssociation of keratoconus with vernal keratoconjunctivitis is well known, but there are few topographic studies describing actual prevalence especially in India where it is a common condition. There is also scarce literature on the topographic patterns and subclinical topographic anomalies in cases of vernal catarrh and their relationship with various subtypes. This study was conducted to estimate the prevalence of subclinical keratoconus among Indian subjects with vernal keratoconjunctivitis and describe the various topographic abnormalities which can help in screening for these cases.MethodsIn the cross-sectional study conducted at a tertiary care center, 76 established cases of vernal keratoconjunctivitis were evaluated with placido disc–based videokeratography for topographic abnormalities and early keratoconus based on modified Rabinowitz–McDonnell criteria.ResultsSeventeen (11.2%) eyes satisfied both the modified Rabinowitz–McDonnell criteria of keratoconus. Corneal topographic pattern analysis showed asymmetric bowtie with inferior steepening in 17.11% of the patients. None of these patients had clinical evidence of keratoconus.ConclusionsThe study showed 11.2% prevalence of keratoconus in patients suffering from vernal keratoconjunctivitis. The findings highlight the importance of using a simple placido disc–based corneal topography system for screening the patients with vernal keratoconjunctivitis for keratoconus. This can help in early detection and preventive intervention.
Abstract: Publication date: Available online 15 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Vivek Aggarwal, A. Jayachandra, Naveen Aggarwal, Faiz Ahmed BackgroundThe aim is to study cardiac abnormalities as detected by transesophageal echocardiography (TEE) in young patients (
Abstract: Publication date: Available online 11 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Dinesh Chander Chaudhary, Vineet Sharma BackgroundTorque is an important component of preadjusted edgewise prescriptions to achieve ideal/optimum tooth position and more so in aesthetics sensitive maxillary anterior teeth. Thus, the need to audit available commercial brands of 018Roth and 022MBT was felt and in vitro analysis of eight brands namely 3M Unitek, Dentaurum, d-tech, IMD Medical, Libral Leone, Modern Orthodontics, Ormco and Ortho Organizer, was carried out.MethodsThe method involved perfect superimposition of two standardized images: one delineating facial axis of the tooth with stainless steel straight wire and other with full dimension arch wire engagement in bracket. The two images were superimposed and opacity of one of the images altered using Adobe Photoshop software to reveal the position of two wires. The angle obtained between two wires gave a direct read-out of torque expression. The comparison was statistically done with one-way ANOVA and Tukey's HSD test.ResultsIn 018Roth group, IMD Medical did not show any significant difference from the standard while comparison independent of standard showed that IMD, Modern Orthodontics and Ormco were not significantly different from each other. In 022MBT group, IMD Medical, d-tech, 3M Unitek and Modern Orthodontics did not have statistically significant difference from and independent of standard.ConclusionSignificant variations from the standard values of both 018 Roth and 022 MBT exist in the market products and thus selection of product must be based on proper guidance in addition to clinical acumen/experience. Also the methodology provides easy to use, inexpensive set-up in the clinical settings.
Abstract: Publication date: Available online 10 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): S.M. Londhe, E. Mahesh Gowda, V.B. Mandlik, M.P. Shashidhar BackgroundImplant restorations are considered an ideal treatment option for replacement of missing teeth in partially edentulous patients. Abutment screw loosening is one of the frequently observed technical complications of implant-supported prosthesis. This study aimed to determine the prevalence and factors associated with the abutment screw loosening in cement-retained single-implant crowns.MethodsEnrolment criteria included partially edentulous patients who have been rehabilitated with one or more cement-retained single-implant crowns with minimum postcementation period of 1 year. They were recalled and evaluated for the presence or absence of screw loosening both clinically and radiographically. They were further evaluated for the presence or absence of factors associated with screw loosening such as parafunctional habits, wider occlusal table, steep cuspal inclines, non-axial loading and cantilevering of the pontic.ResultsTwenty-six cement-retained single-implant crowns out of 280 showed screw loosening, making the overall prevalence rate of 10.77%. Among the factors evaluated, parafunctional habits were associated with three cases, wider occlusal table in four, steep cuspal inclines in three, non-axial loading in nine and cantilevering of the pontic in three cases. Exact reasons could not be ascertained in four cases.ConclusionAbutment screw loosening seems to be a significant prosthetic complication of cement-retained single-implant crowns. Factors evaluated significantly affect the functional durability of the prosthesis. These factors should be considered while restoring to enhance the longevity of such restorations.
Abstract: Publication date: Available online 10 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): V. Manu, Tin Aung Hein, Dibyajyoti Boruah, V. Srinivas BackgroundThe aim of this study was to evaluate the expression of p53, p16, Wilms tumor gene (WT1), and Mindbomb E3 Ubiquitin Protein Ligase 1 (MIB-1) index by immunohistochemical (IHC) staining in benign, low-grade, and high-grade serous ovarian tumors.MethodsForty-one cases of ovarian serous tumors were included in the study (benign serous tumor [n = 10], low-grade ovarian serous carcinoma [n = 8], and high-grade ovarian serous carcinoma [n = 23]). Expression of p53, p16, WT1, and MIB-1 by IHC was evaluated statistically with the grade of tumor. Semiquantitative scoring system for percentage (0–5) and intensity (1–3) of staining pattern was used to bring about objectivity.Resultsp53, p16, and WT1 showed significantly higher staining scores in ovarian serous carcinoma group than in the benign group (p
Abstract: Publication date: Available online 10 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Rahul Tyagi, S. Srinivas, Anupam Kapur
Abstract: Publication date: Available online 10 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): V. Manu, Barun K. Chakrabarty, Shivinder Singh BackgroundSepsis is a major global healthcare concern. Platelets and leucocytes play a key role in sepsis. Whole blood flow cytometry (FCM) is a powerful new technique for the assessment of leucocyte and platelet parameters and their functional state. In the present study, we have used FCM to examine platelet and leucocyte functions and parameters in sepsis patients.MethodsProspective, non-interventional cohorts of all adult patients with sepsis and history of intensive care unit stay for more than 24 h at mixed surgical- medical ICU were evaluated. The Simplified Acute Physiology Score-3 (SAPS 3) admission score was obtained, and whole blood FCM analysis of select platelets and leukocyte parameters were performed using a combination of monoclonal antibodies in a predefined panel. We also evaluated the correlation between these parameters and the severity of the illness, based on SAPS 3 admission score.ResultsTotal leucocyte count (TLC) was statistically and significantly different between all the study samples, but platelet count was not. SAPS 3 acted as the best discriminant between the study groups. With a cut-off score of 55.5, SAPS 3 score predicted hospital mortality with a sensitivity of 82.8% and a specificity of 83.9%, with an area under receiver operating curves (AUROC) of 0.888 (95% CI = 0.807–0.969, p < 0.000). Parameters for CD62P, platelet-leucocyte aggregates (PLAs) and CD11b showed statistically significant differences between the patients and healthy volunteers. CD62P expression was positively correlated to PLA variables in severe sepsis patients. The median fluorescence intensity was found to be more informative than mean fluorescence intensity. New “62P adhesion index (62P AI)” and “PLA adhesion index” are proposed and is likely to be more informative.ConclusionSAPS 3 score was the most robust of the parameters evaluated. Our study suggest the idea that the incorporation of platelet and leucocyte activation parameters, rather than mere static counts, will add the existing prognostic model though we could not conclusively prove the same in this study.
Abstract: Publication date: Available online 6 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): Subhendu Pandit BackgroundBody donation is considered an altruistic act done by people for advancement of science. There has been a significant depreciation in the availability of cadavers for teaching and research all over the world. Unlike India, many countries have studied the profile and attitudes of potential body donors to improve body donation. With a huge health sector, this Indian study studied the profile and attitudes of body donors and their role in aiding science through body donation.MethodsFour hundred thirty-one survey forms with informed consent were sent to registered body donors. The questionnaire focused on demographic parameters and their perception on body donation. The data were collated, compared and interpreted with similar studies done worldwide.ResultsThe study shows an interesting pattern among the Indian donors in comparison to the West. An Indian donor is a male individual in 70s, highly educated and religious with good social background. Despite many similarities, there are important distinguishing features unique to our country and many myths surrounding body donation.ConclusionThe Indian donor is highly educated male and charitable with strong belief in God. He believes in aiding medical science through body donation.
Abstract: Publication date: Available online 6 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): S. Sawhney, R.K. Singh, S. Chakraberty BackgroundIntrathecal adjuncts have been used to prolong the quality and duration of subarachnoid anaesthesia. Midazolam given intrathecally is reported to have antinociceptive properties. The purpose of this study was to compare intrathecal midazolam with fentanyl for pain relief and patient comfort.MethodsIn this prospective, double-blind, randomised controlled trial, 90 patients for lower limb surgeries were randomly allocated to three groups: “control group” (3 ml 0.5% heavy bupivacaine), “fentanyl group” (3 ml 0.5% bupivacaine + 10 mcg fentanyl) and “midazolam group” (3 ml 0.5% bupivacaine + 1 mg midazolam). Level, duration, and quality of blocks were compared along with the duration and quality of postoperative analgesia. Haemodynamic stability and any associated complications were also noted.ResultsOnset of block was fastest in Group C (28.5 ± 13.48 min) vis-a-vis other groups (35.5 ± 26.05 min for Group “F” and 28.5 ± 23.68 min for Group “M”; P = 0.51). Duration of block was comparable in all groups (130.5 ± 39.3 min Group “C”; 126.5 ± 44.0 min Group “F” and 129.5 ± 45.7 min Group “M”; P > 0.5).Addition of adjuncts did not significantly defer the appearance of pain. Intensity of pain was lower in Group “M”. Average VAS scores were lower for Group “M” (3–4) than those for Group “C” (4–5) and Group “F” (4–6).Majority of patients required at least one dose of rescue analgesic; however, those receiving fentanyl reported better quality of postoperative analgesia than those in midazolam group.ConclusionAdjuvants improve quality of postoperative analgesia (fentanyl better than midazolam).
Abstract: Publication date: Available online 6 October 2018Source: Medical Journal Armed Forces IndiaAuthor(s): K. Venkatnarayanan, Harmeet S. Arora, Aparajita Gupta, K.M. Adhikari
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Saurav Das, Shankar Narayan, Sunil Rai BackgroundThe incidence of Vitamin D deficiency (VDD) among newborns is very high in India, this is usually secondary to maternal deficiency. Currently Vitamin D at the dose of 400–600 IU/day is being prescribed during pregnancy for prevention. There is paucity of data regarding efficacy of current recommendations in preventing neonatal hypovitaminosis D.Our aim was to determine if good nutritional status of the mother and regular calcium and Vitamin D supplementation during pregnancy in the currently recommended doses help prevent or reduce VDD in neonates.MethodsCord blood Serum 25(OH)D levels were studied in 342 neonates born to 323 healthy mothers at a tertiary care center in Mumbai. All the mothers were on regular antenatal follow up and received Vitamin D and calcium supplements as per current recommendations.ResultsMean umbilical cord blood 25(OH)D level was 12.088 ng/ml (SD 3.349, range 31.1–5.1). Out of 342 neonates, 335 (97.95%) had Vitamin D deficiency [cord blood 25(OH)D level 30 ng/ml. However, none of the neonates in the study were found to have severe VDD (
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): R.K. Anadure, Vinny Wilson, Samaresh Sahu, Anuj Singhal, Satish Kota BackgroundA prospective, observational study was done at a tertiary care hospital in Western Maharashtra to describe the etiologies, clinical features, diagnosis and prognosis of cerebral venous sinus thrombosis in an Indian population.Methods54 patients with clinical and MRI features suggestive of cerebral venous sinus thrombosis (CVST), were studied with detailed clinical evaluation and pro-thrombotic work up. All were followed up monthly for 6 months, to assess the response to therapy and clinical outcomes.ResultsThe mean age of presentation was 35 years. Headache was the most common presenting symptom (94%) and hemi paresis (22%) was the most common neurological sign. The most common sinus involved was transverse sinus in 77% of cases. In the unprovoked CVST subset (n = 29), elevated factor VIII (72%) and protein C deficiency (24%) were the common prothrombotic states identified. In the provoked CVST subset (n = 18), puerperium (44%) and para-infectious (22%) accounted for majority cases. Idiopathic CVST accounted for 13% (7/54) in this study. A Modified Rankin Scale (MRS) of 0–1 was achieved in 96% of patients at the end of 6 months follow up with no mortality in this study.ConclusionCVST is an important yet under recognized cause of intracranial hypertension and stroke in young. Clinical presentation is extremely varied and a high index of suspicion is needed. Magnetic Resonance Imaging (MRI) brain with Magnetic Resonance Venography (MRV) is the current diagnostic modality of choice. Elevated factor VIII and puerperium are the common etiologies in an Indian population. Management with anticoagulants is safe and has excellent clinical outcomes.
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Mahadevan Kumar, M. Mugunthan Polymerase chain reaction (PCR) based assays have been developed to amplify DNA of fungal pathogens as culture-based detection methods show low sensitivity. In order to perform a sensitive, specific, and reliable PCR based assay, the availability of pure DNA as well as an easy-to-perform DNA extraction protocol is essential. The existing protocols for DNA extraction used for bacteria or viruses show poor release of fungal DNA. In this study, we evaluated three different methods of DNA extraction and compared their efficacy in the extraction of DNA from filamentous fungi, yeasts, and dermatophytes commonly isolated in our laboratory. It was found that the Fungi/Yeast Genomic DNA Isolation Kit (Norgen Biotek Corp, Ontario, Canada) demonstrated satisfactory extraction of DNA from all the fungi analyzed as compared to that of the Qiamp DNA extraction kit (Qiagen GmbH, Dusseldorf, Germany) or the Phenol Chloroform Isoamyl alcohol extraction method which failed to extract amplifiable DNA from many of the fungal species. Thus, we recommend the use of Fungi/Yeast Genomic DNA Isolation Kit (Norgen) with modifications for the extraction of DNA from fungal cultures.
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): I.D. Khan, A.K. Sahni, Sourav Sen, R.M. Gupta, Atoshi Basu BackgroundPrototheca is an emerging, opportunistic, pathogenic, zoonotic achlorophyllous green alga, expanding in pathogenicity and host range, causing localized and disseminated infections. This outbreak of Prototheca wickerhamii algaemia and sepsis in a tertiary care 30-bedded chemotherapy oncology unit is the first human outbreak to the best of our knowledge.MethodsP. wickerhamii algaemia was confirmed on consecutive isolation. Person to person transmission was hypothesized considering all patients in the unit at risk. Clinico-demographic, diagnostic and treatment profile were correlated. Both manual and automated systems were used for blood culture, isolation, identification and susceptibility of Prototheca. Liposomal amphotericin B was given. Outbreak surveillance of faeces, fingertips and environmental reservoirs, retrospective surveillance during past 15 years and prospective surveillance was continued for two years.ResultsThe outbreak affected 12 neutropenic patients over 50 days. No specific clinical features were noted. The hypothesis could not be substantiated. P. wickerhamii was isolated as yeast-like colonies revealing Gram positive yeast-like cells without budding and pseudohyphae which were confirmed by automated system. Post amphotericin B blood cultures were negative for Prototheca. Surveillance studies were not contributory.ConclusionP. wickerhamii has no documented reservoirs or transmission. Endogenous colonization in the gut followed by translocation during chemotherapy induced immunosuppression is likely to cause algaemia and sepsis. Outbreaks are difficult to detect and control as incubation period is variable and clinical presentation is muted, emphasizing the need to strengthen hospital and laboratory based surveillance systems to ensure adequate preparedness, rapid detection and response to outbreaks.
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Navjyot Kaur, Velu Nair, Sanjeevan Sharma, Puja Dudeja, Pankaj Puri BackgroundMegaloblastic Anemia (MA) is a relatively common disease, yet the data on prevalence of MA remains scarce. This study was conducted to study the prevalence and clinico-hematological profile of MA.MethodsThis was a cross-sectional study done on 1150 adult anemic patients. All patients diagnosed to have MA were studied for clinico-hematological and etiological profile. Nerve conduction studies (NCS) were done in all.ResultsMA was present in 3.6% cases of anemia. Severe anemia was seen in 9.7% of anemic patients and 75% of MA cases (p
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): M.S. Vinod, Subhash Chandra Shaw, Amit Devgan, Sweta Mukherjee
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Manish Ranjan, Santosh Karade, Sourav Sen, V. Srinivas
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Shazia Khan, Virendra Singh, I.D. Khan, Sujatha Panda
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Saikat Bhattacharjee, Preema Sinha, Arti Sarin, B.K. Prasad Neurofibromatosis is a neurocutaneous, tumor predisposing, inheritable disorder characterized by tumors of the brain and spine and the presence of skin lesions. The most important tumors associated with neurofibromatosis are vestibular nerve schwannomas, with others being meningiomas and ependymomas. The cord is also affected by tumors, ependymoma being the commonest, besides meningiomas and schwannomas. We present a case with café au lait macules, neurofibromas in the skin, bilateral VIII cranial nerve schwannomas, multiple meningiomas in the brain and spine, ependymomas in the brain and spine, and schwannomas in the cauda equina nerve roots.
Abstract: Publication date: October 2018Source: Medical Journal Armed Forces India, Volume 74, Issue 4Author(s): Bitan Saha, H. Krishna Kumar, Manash P. Borgohain, Rajkumar P. Thummer Soldiers involved in combat operations worldwide may be subjected to a wide array of tissue-specific injuries of varying degrees, thereby undergoing complicated medical treatments and prolonged rehabilitations. In many cases involving inadequate recovery, soldiers are further mentally traumatized as they can no longer serve their beloved country. In addition, many severe injuries can lead to soldiers being incapacitated for life and unable to perform even the most basic day-to-day activities. Present therapy for combat injuries is majorly aimed at alleviating pain and limiting further tissue damage from secondary infections. Cell-based therapy using stem cells is a promising tissue regenerative source, which will help our soldiers to recuperate from the severe injuries, and in some cases, even continue their service for the country after complete recovery. In this context, we would like to discuss the yet fully untapped potential of induced pluripotent stem cells (iPSCs) in regenerative medicine on the battlefield. In this review, we shall try to explore the rationale behind the use of these cells for military medicine, as well as the conventional and novel approaches to produce them for therapeutic applications. We shall also attempt to elucidate the evolving trends of battlefield injuries throughout history and the ongoing research on regeneration of tissues of specific interest using iPSCs and their potential role in combat medicine in the future. Additionally, we shall also discuss the concept of stem cell bio-banking for military personnel as a personalized safeguard against crippling and traumatic combat injuries.
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